Often the choice of home health agency happens fast, on discharge day, with a case manager handing over a list. Knowing your rights and a handful of good questions lets you make that choice on purpose instead of by default.
You get to choose
Federal hospital rules require the discharge plan to include a list of Medicare-participating home health agencies that serve your area, and the hospital must tell you that you are free to choose among them. The hospital must also disclose any agency in which it has a financial interest, and help you use quality data to choose. If you are in a Medicare Advantage plan, confirm which agencies are in network.
First, is it home health or home care?
Medicare home health is skilled nursing and therapy for someone who is homebound and has a doctor’s order. It comes in short visits for a limited period. If what your loved one really needs is daily help with bathing, dressing and meals, that is personal care, which Medicare does not cover by itself. Many families need both. See home health in Utah for how the two differ.
Use the star ratings
On Medicare’s Care Compare, each certified agency can have two ratings:
| Rating | Built from | Look especially at |
|---|---|---|
| Quality of patient care | Patient assessments and Medicare claims | Timely start of care, improvement in walking and bathing, preventable hospital stays |
| Patient survey | The Home Health CAHPS survey of patients | Communication and how patients rated the agency overall |
Both are updated quarterly. An agency needs at least 40 completed surveys in a year to receive a patient survey rating, so newer or smaller agencies may show none.
Questions to ask the agency
Getting started
- Can you start within a day or two of discharge? What day would the first nurse visit be?
- Do you have the therapists we need, physical, occupational or speech, available in our area now?
Day to day
- How many visits a week should we expect, and how long is each?
- Will we see the same nurse and therapist most of the time?
- How will you tell us your arrival window?
After hours
- Who answers if we call at night or on a weekend, and can a nurse come out?
When it ends
- How will you decide when skilled care is finished, and how much notice will we get?
- Can you recommend licensed personal care if my parent still needs help after that?
If you also need personal care
In Utah, non-medical in-home help comes from personal care agencies licensed under rule R432-725. These agencies help with daily activities that do not require a licensed professional. Ask about background checks, how aides are supervised (Utah requires a licensed nurse or an experienced certified nursing aide, with on-site evaluations every six months), and how they cover a missed shift.
Signs things are not working
- Missed visits, or visits much shorter than promised.
- No clear plan of care, or nobody can tell you the goals.
- Calls that are not returned the same day.
If this happens, call the agency’s director of nursing. You can also switch agencies; ask the doctor for a new referral.
What the first visit looks like
Usually a nurse or therapist comes first to do a full assessment. They review medications, check vital signs and wounds, look at how your loved one moves around the house, and ask about goals. From that visit comes a plan of care, signed by the doctor, that sets how often each discipline will visit and what they are working toward.
Have these ready for the first visit:
- All discharge papers and the hospital’s medication list.
- Every pill bottle in the house, including vitamins and over-the-counter medicines.
- Insurance cards and the name of the doctor who will follow your loved one.
- A short list of your own questions and worries.
Getting the home ready
Clear pathways of rugs and cords, put a nightlight between the bedroom and bathroom, and place often-used items within easy reach. The therapist may recommend equipment such as a shower chair, raised toilet seat or grab bars. Medicare covers some medical equipment with 20% coinsurance after the Part B deductible, so ask which items are covered before you buy.
Being a good partner in care
Home health works best when the family is part of the team. Watch a therapy session and ask the therapist to show you the exercises, so practice can continue between visits. Keep a notebook by the door where nurses, therapists and family can jot notes. Tell the agency right away about falls, new confusion, a fever, or a wound that looks worse, rather than waiting for the next scheduled visit. And ask early what “done” looks like, so the end of services is a planned step instead of a surprise.
Common questions
Can I choose my own home health agency with Medicare?
Yes. The hospital must give you a list of Medicare-participating agencies that serve your area and respect your choice when possible.
What do home health star ratings mean?
One rating reflects clinical results like improvement and timely care; the other reflects what patients said in a survey. Both are on Care Compare.
Does Medicare pay for a home health aide?
Only part-time aide help, and only while your loved one is also receiving skilled nursing or therapy.
Can we switch home health agencies?
Yes. If visits are being missed or the care is not working, ask your loved one’s doctor for a referral to a different Medicare-certified agency that serves your area.
Want help sorting it out? A Utah Care Network guide can talk it through with you, free. Tell us about your loved one or call 801-859-7000.
Sources
- Medicare.gov: Home health services
- CMS: Home health star ratings
- 42 CFR 482.43: Hospital discharge planning
- Utah DLBC: Personal care agency rule R432-725 (PDF)
This guide is general information, not medical, legal or financial advice. Coverage rules change; confirm details with the program or your plan.
